MEDICARE: DIAMOND PRIVATE PHYSICIANS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1447507371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAMOND PRIVATE PHYSICIANS, PLLC

Provider Business Mailing Address
First Line	:	2201 WOLF ST
Second Line	:	APT 5201
City	:	DALLAS
State	:	TX
Zip	:	75201-1137
Country	:	US
Telephone Number	:	214-395-3491
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 WOLF ST
Second Line	:	APT 5201
City	:	DALLAS
State	:	TX
Zip	:	75201-1137
Country	:	US
Telephone Number	:	214-395-3491
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. JAMES PINCKNEY II
Credential	:	M.D.
Telephone Number	:	214-395-3491

Provider Enumeration Date	:	08/09/2012
Last Update Date	:	08/09/2012

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